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Music one of the things that's driving at the cost of care is a new term it's called pass-through billing and today we're here with Cheryl McClure is a divisional senior vice-president health care delivery so sure what is pass-through billing so stick with me it's kind of complicated okay but as you know we negotiate for the prices that we pay to our providers some providers negotiate higher prices and other providers negotiate lower prices well sometimes if a provider with a lower price somehow convinces the provider with a higher price to bill on their behalf even though that higher price providers not providing the service that's what pass-through billing is okay so let me get this right alright so I could decide to make a decision to go to a higher value let's just say hospital okay because I'm having a procedure done and at the hospital I get a service done and I'm gonna say laboratory right and I get my lab done in the bill comes from the hospital where I had the service done but are you telling me that the radon pain might be from someone else who's just using that hospital to build it it could it could be from another hospital it could be from a hospital in another state it could be from a hospital that had absolutely nothing to do with the service that you were provided you can even go to okay so needs to this sounds kind of shady to me it sounds like that people are using contracts to just take as much money from a patient as they can is that is that what I think that's accurate that's what we're seeing and when we find it we address the contract we address the provider there have even been some legal and fully implications around licensure because maybe the higher price provider doesn't even have no licensure to prthe service I think I saw an example is that where where somebody had a surgery done and they a pathology bill but there's really no pathologist even working for the hospital is that fair yes so the other thing that's a little shady about this is that patients may never know patients might not know until they get their bill or their explanation of benefits after the fact and then what do you do about it so if so let's say you get an explanation of benefits or a bill and it's from a provider or describes it might describe the service that you received but if it's by a provider that you had no knowledge of accessing then that could be a pass-through bill situation so in other words it's almost a type of fraud I think that in certain circumstances so if the patients are an example about that then they should call the number on the back of their insurance card and ask questions and figure out what's going on absolutely.